Dr. Paul DRAKEFORD
Consultant Anesthesiologist – Royal Prince Alfred Hospital, Sydney, Australia
B.Bus, M.B.B.S (Hons) USyd, MMed (Periop Medicine), FANZCA
Dr Drakeford is an Australian anesthesiologist who completed his medical training in Sydney before relocating to Singapore where he worked at Tan Tock Seng Hospital for 6 years. He returned to Australia in 2021 and is now based primarily at Royal Prince Alfred and Lifehouse Hospitals in Sydney. He has a keen interest in Perioperative Medicine and has been involved in Enhanced Recovery after Surgery (ERAS) programs in Singapore and Australia. His main focus is hemodynamic optimization and lung protection strategies for the high-risk surgical patient. Before returning to Australia he was also the anaesthetic lead for cytoreductive surgery (HIPEC), major liver resection surgery, and emergency laparotomy at Tan Tock Seng Hospital.
While mortality from anaesthesia is thankfully low, postoperative complications such as myocardial injury after non-cardiac surgery and acute kidney injury are still relatively common and are associated with increased cost to the healthcare system. All but the most diligent anesthesiologists will be unaware of these complications as they generally occur in the days following surgery rather than intraoperatively. One tool for reducing postoperative complications is the use of goal directed hemodynamic therapy (GDHT) in higher risk patients. GDHT utilizes advance monitoring techniques, along with fluids and vasoactive medications to augment oxygen delivery to vital tissues and organs. This presentation will discuss the evidence for GDHT and delve into the fundamentals of a GDHT protocol to use both intraoperatively and in the immediate post operative phase. The difference between dynamic and flow-based means of assessing fluid responsiveness, the cornerstone of GDHT, will be discussed along the limitation of these measurements.